June 11, 2018

WASHINGTON – Leaders of six medical organizations representing more than 560,000 physicians and medical students called on Congress today to adopt policies that recognize opioid use disorder (OUD) as a chronic disease of the brain that requires comprehensive treatment. Doing so, the medical leaders said, would hold greater promise of successfully addressing the OUD epidemic.

The organizations—the American Academy of Family Physicians, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American College of Physicians, American Osteopathic Association and American Psychiatric Association—made their recommendations in “Addressing the Opioid Epidemic: Joint Principles.”

The medical organizations urge policymakers to implement solutions that focus on the opioid crisis, but also address other serious substance use disorders that devastate families.

“As a society, we need to ensure that people struggling with opioid use disorder—and this includes family members as well as patients—have access to comprehensive care,” said Altha Stewart, MD, president of the American Psychiatric Association. “Just like people with any other chronic illness, these patients must have coverage for treating a chronic brain disease. The doctors who treat them must be able to respond quickly during relapses and to provide ongoing care management without administrative delays that can lead to emergencies, inpatient care or other high-cost treatment.”
The joint principles set out guidelines to expand access to treatment and increase research into substance use disorder prevention and treatment. They also call for a public health approach SUDs that will reduce stigma while continuing to ensure comprehensive pain management for patients.

The joint principles include:

Align and improve financing incentives to ensure access to evidence-based SUD treatment.
“Persons with low-income who are struggling with opioid use disorder must have access to Medicaid coverage,” said Ana María López, MD, MPH, FACP, president of the American College of Physicians. “This means policies must extend coverage to adults in non-expansion states and maintain Medicaid’s existing financing structure without caps or other changes that shift the cost to the states. Equally important, policies should mandate that Medicaid and Medicare pay for comprehensive medication-assisted treatment at the same rate they pay for other chronic illnesses.”

Reduce the administrative burden associated with providing patients effective treatment.
“When patients seek treatment for opioid use disorder, they need to get it now,” said Michael Munger, MD, president of the American Academy of Family Physicians. “They can’t wait until the doctor has obtained prior authorizations for services or for dispensing medications. We’re pleased some insurers have lifted prior authorizations for medication-assisted treatment, but we need to see more progress in order to minimize delays and increase the time physicians can spend with their patients.”

Incentivize more providers to treat SUD.
“We must ensure that patients have access to health professionals who can meet their needs,” said APA’s Stewart. “An estimated 2.1 million Americans suffer from untreated SUDs. If we’re going to have a strong behavioral health workforce, our policies must provide incentives such as education loan forgiveness, for those who provide care in underserved areas. We need policies that strengthen telepsychiatry and integrated health models that help fill the need in rural and underserved areas.”

Advance research to support prevention and treatment of substance abuse disorders.
“One of the most important elements of preventing and treating substance use disorders is understanding the safety and effectiveness of alternatives to opioid medications,” said Lisa Hollier, MD, president of the American College of Obstetricians and Gynecologists. “Many of today’s non-opioid pain relief options are contraindicated for use during pregnancy. The National Institutes of Health must have the tools and flexibility to support innovative research on alternatives to opioids and appropriate opioid prescribing to treat pain without triggering addiction.”

Ensure a public health approach to SUDs by addressing childhood stress, access to naloxone, and fair and appropriate treatment for individuals in the criminal justice system and pregnant women.
“Opioid use disorder is a public health crisis, and our policies must take a comprehensive public health approach to it,” said AAFP’s Munger. “With that focus, we can avoid long-term, adverse health consequences from children who suffer from trauma associated with a family member who has an untreated opioid use disorder. We will save lives by providing targeted distribution of naloxone in the community. We can prevent relapse and death among former inmates who had inadequate SUD treatment during their incarceration.”

Address the maternal-child health impact of the opioid crisis.“Parental substance use has a significant impact on child health and wellbeing,” said Colleen Kraft, MD, MBA, president of the American Academy of Pediatrics. “More than a third of children entering foster care do so at least in part because of parental substance use. However, the science tells us that we can often better address the needs of affected families by providing access to evidence-based treatment for the whole family. We need policies that support access to familial treatment and prevent unnecessary foster care placements when children can remain safely with their parents, including effective implementation of the Family First Prevention Services Act.”

Continue to provide comprehensive pain management for patients
“It’s vitally important that we take care of patients suffering from chronic pain, who are the most common recipients of opioid medications,” said Mark A. Baker, DO, president of the American Osteopathic Association. “While our policymakers focus on preventing opioid misuse, they also must ensure that patients suffering debilitating, chronic pain have access to the most appropriate treatment. For those patients whose treatment depends on opioid analgesic, our policies must not interfere with the physician-patient relationship that is essential to ensuring appropriate pain relief without addiction.”

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About American Academy of Family Physicians
Founded in 1947, the American Academy of Family Physicians represents 131,400 physicians and medical students nationwide, and it is the only medical society devoted solely to primary care.

Family physicians conduct approximately one in five of the total medical office visits in the United States per year – more than any other specialty. Family physicians provide comprehensive, evidence-based, and cost-effective care dedicated to improving the health of patients, families and communities. Family medicine’s cornerstone is an ongoing and personal patient-physician relationship where the family physician serves as the hub of each patient’s integrated care team. More Americans depend on family physicians than on any other medical specialty.

About the American Academy of Pediatrics
The American Academy of Pediatrics is an organization of 66,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org and follow us on Twitter @AmerAcadPeds.

About The American College of Obstetricians and Gynecologists
The American College of Obstetricians and Gynecologists (ACOG) is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of more than 58,000 members, ACOG strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. www.acog.org
About the American College of PhysiciansThe American College of Physicians is the largest medical specialty organization in the United States with members in over 145 countries worldwide. ACP membership includes 152,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter and Facebook.

About the American Osteopathic Association
The American Osteopathic Association (AOA) represents nearly 137,000 osteopathic physicians (DOs) and osteopathic medical students; promotes public health; encourages scientific research; serves as the primary certifying body for DOs; and is the accrediting agency for osteopathic medical schools. To learn more about DOs and the osteopathic philosophy of medicine, visit www.DoctorsThatDO.org.

About the American Psychiatric Association
The American Psychiatric Association is the oldest medical association in the country founded in 1844. The APA is also the largest psychiatric association in the world with more than 37,800 physician members specializing in the diagnosis, treatment, prevention and research of mental illnesses. APA’s vision is to ensure access to quality psychiatric diagnosis and treatment. For more information please visit www.psychiatry.org.

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The American College of Obstetricians and Gynecologists (ACOG), is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of more than 58,000 members, ACOG strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care.www.acog.org